不同剂量双抗治疗对不同基线血压水平轻型脑卒中病人院内结局的影响  

Effect of Dual Antiplatelet Therapy on Hospital Outcomes in Minor Stroke Patients with Different Baseline Blood Pressure

作　　者：李亚丽 刘亭亭[2] 王永乐 李亚楠[1] 张凯丽 樊海梅 李娟[1] 任静 李新毅 吴雪梅 牛小媛[2] LI Yali;LIU Tingting;WANG Yongle;LI Yanan;ZHANG Kaili;FAN Haimei;LI Juan;REN Jing;LI Xinyi;WU Xuemei;NIU Xiaoyuan(Shanxi Medical University,Taiyuan 030001,Shanxi,China;First Hospital of Shanxi Medical University,Taiyuan 030001,Shanxi,China;Shanxi Bethune Hospital;Taiyuan Iron&Steel(Group)Co.,LTD General Hospital;Shanxi Cardiovascular Hospital)

机构地区：[1]山西医科大学,太原030001 [2]山西医科大学第一医院,太原030001 [3]山西白求恩医院 [4]太原钢铁(集团)有限公司总医院 [5]山西省心血管病医院

出　　处：《中西医结合心脑血管病杂志》2025年第2期197-207,共11页Chinese Journal of Integrative Medicine on Cardio-Cerebrovascular Disease

基　　金：山西重点研发计划项目(No.201903D32111751081122114585885114)。

摘　　要：目的:观察不同剂量双抗治疗对不同基线血压水平轻型脑卒中病人院内结局的影响。方法:纳入2010—2018年连续就诊于山西省3所高级脑卒中中心的发病72 h内、美国国立卫生研究院卒中量表(NIHSS)评分≤5分的轻型脑卒中病人。根据入院时首次使用的抗血小板聚集方案将病人分为阿司匹林单药治疗(AM)组、阿司匹林和氯吡格雷负荷双重抗血小板聚集治疗(DAPT-ALC,第1天氯吡格雷负荷剂量300 mg)组、阿司匹林和氯吡格雷非负荷双重抗血小板聚集治疗(DAPT-AUC,第1天氯吡格雷剂量75 mg)组。根据入院时病人血压,按照收缩压(<140 mmHg、140~<180 mmHg和≥180 mmHg)、舒张压(<90 mmHg、90~<110 mmHg和≥110 mmHg)进行分组。多组间连续变量比较采用单因素方差分析,分类变量比较采用χ2检验或Fisher确切概率法;采用Logistic模型拟合分析院内结局。结果:共纳入1312例病人。与AM组比较,DAPT-ALC组病人更年轻,入院时间更早,吸烟史、冠心病病史、心肌梗死病史、颅内动脉狭窄和发病时使用他汀比例更高,差异均有统计学意义(P<0.05);DAPT-AUC组较AM组病人更年轻、入院时收缩压水平更高、无脑出血病史比例更高,差异均有统计学意义(P<0.05)。全部病人中,调整混杂因素后,与AM组比较,DAPT-ALC组可降低院内复合脑卒中事件发生率;与AM组比较,入院时收缩压<140 mmHg的病人从DAPT-ALC中获益;与AM组比较,入院时收缩压≥180mmHg的病人从DAPT-AUC中获益;与AM组比较,入院时舒张压90~<110mmHg的病人从DAPT-ALC中获益。结论:不同剂量抗血小板聚集治疗不同基线血压水平轻型脑卒中的院内结局获益不同,提示在临床实践中,个体化抗血小板聚集治疗决策对病人的结局影响有意义。Objective:To observe the effect of dual antiplatelet therapy on hospital outcomes in minor stroke patients with different baseline blood pressure.Methods:Minor stroke patients with National Institutes of Health Stroke Scale(NIHSS)score≤5 were included.The patients were divided into aspirin monotherapy(AM)group,dual antiplatelet therapy of aspirin plus loading dose clopidogrel(DAPT-ALC,clopidogrel loading dose 300 mg at the first day)group,and dual antiplatelet therapy of aspirin plus unloading dose clopidogrel(DAPT-AUC,clopidogrel 75 mg at the first day)group.The patients were divided into to systolic blood pressure(<140 mmHg,140~<180 mmHg,and≥180 mmHg)subgroup and diastolic blood pressure(<90 mmHg,90~<110 mmHg,and≥110 mmHg)subgroup based on blood pressure records at admission.Comparisons of continuous variables between multiple groups were performed by one-way analysis of variance,and comparisons of categorical variables were performed by theχ2 test or Fishers exact probability method.Logistic model fitting was used to analyze in-hospital outcomes.Results:A total of 1312 patients were included.Compared with AM group,patients in DAPT-ALC group were younger,admitted earlier,with higher rates of smoking history,coronary heart disease history,myocardial infarction history,intracranial artery stenosis,and statin use at onset(P<0.05).Compared with AM group,the patients in DAPT-AUC group were younger,with higher systolic blood pressure at admission,and showed a higher proportion without history of cerebral hemorrhage(P<0.05).After adjusting for confounding factors,DAPT-ALC group showed decreased incidence of compound stroke events in hospital compared with that of AM group.Compared with the AM group,patients with systolic blood pressure<140 mmHg at admission could be benefited from DAPT-ALC.Compared with the AM group,patients with systolic blood pressure≥180 mmHg at admission could be benefited from DAPT-AUC.Compared with the AM group,patients with diastolic blood pressure of 90~<110 mmHg at admission could be

关 键 词：轻型脑卒中 入院基线血压 双抗 院内结局 

分 类 号：R743.3[医药卫生—神经病学与精神病学]